If there is a problem—e.g., when our own immune system starts to attack the thyroid gland, the body produces antibodies called TPO (anti-thyro-peri-oxidase); presence of TPO antibodies in a blood test is an indication of such an attack.

What are thyroid hormones?

The thyroid hormones have about 80% T4 and 20% T3. Out of the two, T3 is the active form of thyroid hormone. Thyroxine (T4), the inactive hormone, converts to T3 by releasing one iodine atom.

An enzyme, called Selenium-iodinase which contains the minerals Selenium and Zinc, helps in this conversion (de-iodination). Therefore, both these minerals are critical for healthy thyroid.

Any interference in their supply, e.g., by excess copper that might bind with Zn can interfere in this conversion.

How are thyroid hormones produced?

Based on our emotions, senses, and other daily activities, the hypothalamus in brain senses the need for thyroid hormones and directs the pituitary glad to release Thyroid Stimulating Hormone (TSH).

Thyroid gland in the throat will then release the amount of thyroid hormones, T3 & T4, based on the amount of TSH released from the brain. It is a closed loop involving TSH, T3, and T4 that fully control the thyroid function.

The body produces antibodies called TPO (anti-thyro-perioxidase or antithyroid microsomal antibody) when there is a problem in this cycle, especially when our own immune system attacks the thyroid gland.

Therefore, a thyroid hormone test needs to check all these four key components, TSH, T3, T4, and TPO to assess the health of thyroid glands.

What is the role of Iodine in thyroid hormones?

The primary role of iodine in our body is to make thyroid hormones. As much as 75% of body’s iodine is in the thyroid glands.

Both low and high amounts can damage the thyroid glands.

Insufficient amount of iodine results in swelling of gland, resulting in a condition called goiter where the throat becomes abnormally large.

High levels of iodine can cause thyroid dysfunction by shutting down the glands completely.

Excess iodine symptoms include headaches, vomiting, mouth sores, metallic taste in mouth, swollen salivary glands and rashes. This happens when supplements like kelp or pills are taken which release a huge burst of iodine in a short period.

The recommended daily allowance (RDA) of iodine is approximately 150 microgram per day. One tablespoon of iodized salt contains almost 300 microgram.

On an average, people in US consume 300-700 microgram of iodine per day.

The main source of iodine in diet is iodized salt. There is no iodine in sodium chloride (table salt), and it is added specifically for iodine supply.

The free running and kosher salts can help reduce this daily excess of iodine, if required.

What is hypothyroidism?

Deficiency of thyroid hormones due to insufficient production of the two hormones in thyroid gland is called hypothyroidism.

It can develop due to problems with thyroid gland, pituitary gland, or hypothalamus since all of them are responsible for producing these hormones.

Early signs are mild and hard to pinpoint to any specific parts of the body since thyroid hormones affect the whole body.

Symptoms can be disregarded as due to old age, fibromyalgia, menopause, recent pregnancy, or stress in life.

The most common feature of hypothyroidism is weight gain.

Approximately 2% of population has severe hypothyroidism and 7-15% has mild thyroid problems.

Low levels of thyroid hormones are observed during times of stress or times of life events when body tries to compensate for any fluctuations in thyroid hormones; typical events for the onset of hypothyroidism are menopause, pregnancy, postpartum.

The list of signs and symptoms of thyroid problems is long as thyroid hormones affect every aspect of the body and can overlap other health conditions.

Subclinical hypothyroidism is a mild disorder more commonly found in older population where the free-T4 levels are normal but TSH levels are elevated. Almost no symptoms of hypothyroidism are observed at the time but chances of developing them in future are high.

Thyroid nodules are abnormal lump-like growths in the thyroid glands. They are not always problematic and should be carefully examined by an endocrinologist.

What are the symptoms of hypothyroidism?

The most important symptoms of hypothyroidism or low thyroid hormones are weight gain, slow metabolism, and fatigue. Here are some of the symptoms in detail:

Weight gain – caused by a vicious cycle when low thyroid hormones slow down the metabolism and the body starts to store extra calories which cause other hormone problems (e.g., insulin resistance) that result in further weight gain.

Loss of appetite – slow metabolism due to low thyroid hormones results in the brain slowing down the appetite centers.

Loss of memory and inability to concentrate – due to slow metabolism and fatigue, memory is sacrificed in favor of other brain functions. Body starts to focus on sleeping and eating instead of concentrating and remembering. Signs similar to Alzheimer’s disease can be caused by severe hypothyroidism, e.g., forgetfulness, inability to concentrate, diminished intellectual function, speech capability, and even energy, libido, and motivation problems.

Depression – 10-15% of depression patients have hypothyroidism. It causes injury to cells that produce serotonin in brain. Low serotonin results in negative moods, inability to experience pleasure, pessimism, and feeling of inadequacy and doom.

Slow metabolism also slows down hair growth making them coarse and brittle. Sometimes hair start to fall, often in clumps. People with hypothyroidism frequently loose hair in the outer third of eyebrows. Fingernails also become brittle.

Fluid retention – resulting in puffiness in the face or around the eyes, thickening of lips, swelling of hands, feet or legs.

Heart problems – fluid retention and buildup around heart weakens it causing it to swell, which interferes with pumping of blood.

High blood pressure – both high and low thyroid hormones cause high blood pressure.

Cardiovascular diseases – low thyroid causes the bad cholesterol (LDL) to rise. Fluid build up around heart can reduce its ability to pump blood. Increased thyroid hormone speeds up the heart and strengthens its pumping action. Therefore a sudden increase in metabolism due to thyroid hormone increase can strain the heart and cause a heart attack.

Menstrual problems and infertility – Thyroid hormone controls muscle contraction in the uterus. Without proper muscle contractions periods may become longer and heavier, and may be prolonged becoming irregular. Without proper contraction bleeding may not stop. In some cases ovaries may not be able to release the egg.

Anemia – the low red blood count of anemia can sometimes be caused by hypothyroidism.

Slow reflexes – a key sign of hypothyroidism. The relaxation phase of a reflex is slowed when a doctor hits the knee with a reflex hammer; the return of the knee to the resting position is delayed and experienced endocrinologists use this as the most sensitive way to determine subtle deficiencies.

Snoring or sleep apnea – excess tissue in neck can interfere with breathing that can cause snoring and poor sleep.

Allergies – many people notice worsening of their allergies due to low thyroid hormones.

What are the causes of hypothyroidism?

Hashimoto’s disease – the most common cause of hypothyroidism that affects approximately 15 million people in US. It is caused when thyroid glands are destroyed by attack from our own immune system. It is seven times more common in women and known to be hereditary.

Other forms of damage to thyroid glands – for example, after pregnancy or defects in enzymes necessary for thyroid hormone production.

Damage to hypothalamus or pituitary glands – by tumor, infection, or surgical removal.

Drugs – lithium is known cause of hypothyroidism and drugs containing lithium or iodine can cause problems.

Dietary causes – excess consumption of uncooked vegetables from Brassica family (broccoli, cauliflower, Brussels sprouts, cabbage, mustard, kale, radishes, turnips); there is no issues when one cooks them or consumes in small quantities.

Pregnancy – hypothyroidism in pregnancy is a serious issue and an estimated 2.5% women have some form of it. But hormone changes may make it difficult to assess. It can have serious intellectual and developmental defects in the baby; that’s why regular test every 6-8 weeks during pregnancy is recommended; however, it is a serious problem in developing countries.

What is hyperthyroidism?

Excess thyroid hormone production is called hyperthyroidism. Stress is one of the key causes of hyperthyroidism. However, it is less common than hypothyroidism.

What are the symptoms of hyperthyroidism?

Symptoms are usually opposite of hypothyroidism, e.g., fast metabolism, and weight loss.

One of the primary symptoms is uncontrollable appetite and people with hyperthyroidism always feel hungry.

Increased appetite sometimes can result in high calorie consumption which may result in increased weight.

Fatigue is observed in both cases due to body being busy fighting under or over production of thyroid hormones.

How to test for thyroid diseases?

It is tricky to diagnose thyroid hormone imbalance just from its symptoms due to various reasons:

Ranges for thyroid blood test results are very narrow.

Symptoms overlap with other conditions and one may dismiss them as due to other problems.

The best test for thyroid function is a blood test which checks for TSH, T3, T4, and TPO.

Such a thyroid blood test for low thyroid function, during early or late stage of thyroid deficiency or an immune attack, on the body can check thyroid disorder.

Where can I get a thyroid test? An at home thyroid test can let you collect a sample from home and get results in less than a week.

What does a thyroid test measure?

There are four key markers that should be measured for a comprehensive thyroid test:

TSH: first indication of thyroid problem is changes in TSH hormone. For an underactive thyroid, TSH levels will rise to stimulate the thyroid to produce thyroid hormones. If problems with thyroid continue, abnormal thyroid hormone levels will be observed. But not in the early stage when they can be compensated by extra TSH. The TSH test should be done during the day time as TSH levels often surge at night even in healthy conditions.

fT3 (free T3 or tri-iodo-thyronine) – of the two thyroid hormones released by the thyroid glands, 20% is T3 and 80% is T4. The T4 is converted to the active T3 form. However, both T3 & T4 are bound to a protein called TBG (thyroid-binding globulin). Only the free form is active and it is the best indicator for potency of that hormone. The test will measure the amount of free T3 in the blood.

fT4 (free T4 or thyroxine) – only about 1% of T4 is unbound and free to be converted into T3 and the test will measure this free form.

Antibodies (TPO, thyroid peroxidase or antithyroid microsomal antibody) – the most common cause of thyroid problems is autoimmune disorder when our own immune system attacks the thyroid gland. The presence of high levels of antibodies will indicate an immune system attaching these glands. Normal TSH but high TPO levels may indicate other autoimmune diseases.

How to maintain healthy thyroid?

Eating lots of fruits and vegetables – as they have anti-oxidants (e.g., beta-carotene, vitamin A, vitamin C). The anti-oxidants are useful for cleaning up oxygen-rich free radicals that hinder the immune system. Immune system attack is one of the main causes of hypothyroidism.

Foods high in Selenium and Zinc – both minerals are anti-oxidants and also crucial for T4 to T3 conversion.

Zinc: found in beef, herring, maple syrup, turkey, wheat bran, sunflower seeds; children with Down’s Syndrome and people with obesity tend to have lower levels of Zinc.

Not eating too many raw goitrogens – these are food sources that contain iso-thio-cyanates that interfere with gland functioning. They include cruciferous vegetables from the Brassica family, e.g., cabbage, broccoli, Brussels sprouts, turnips, rutabaga, mustard, kohlrabi, radishes, cauliflower, cassava, millet, and kale. They only cause problems when eaten in large quantities and raw.

Peaches, peanuts, pine nuts, spinach, and strawberries can also inhibit thyroid function when eaten in large amounts. There is no need to eliminate these food items from diet but it helps if one avoids eating in large quantities and over a long period.

Avoid excessive soy in diet – soy is one of the best natural sources of protein that is also vegetarian and vegan. But the estrogen-like compounds in it can block absorption and action of thyroid hormones when consumed in excess.

Physical activity – regular exercise is critical for hormone balance and healthy metabolism. It is best to exercise during a time of the day when your energy levels are at their peak.

Disclaimer: For information purposes only, not to be used for diagnosis or replace advice from a medical professional. An at-home thyroid test can be ordered here. See the full list of our CLIA-certified at-home health tests at www.RxHomeTest.com. All tests include physician’s prescription, free shipping, and physician approved reports.

Last updated: 15 Oct 2018 by Anil Kumar, PhD

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